2015-2016年上海市某社区老年人骨质疏松追踪调查

目的通过追踪2015-2016年上海市某社区65岁及以上老年人的骨密度监测结果,分析社区老年人群骨质疏松疾病发生发展变化与关键影响因素,为社区老年骨质疏松的防治管理提供参考。方法以上海市某社区连续2年(2015-2016年)参与社区健康体检的老年人共4 624名作为研究对象,进行问卷调查(包括一般情况、生活方式)及骨密度检查。采用SPSS 23.0进行数据统计分析,配对t检验分析老年人群连续2年骨密度T值的变化差异,符号Wilcoxon秩和检验分析老年人群连续2年骨质疏松分级的变化差异,采用广义估计方程分析一般情况与生活方式对老年骨质疏松的影响作用。结果本次研究共收集有效数据4 227例,有效率为91.41%。4 227名老年人中,男性占43.46%(1 837/4 227),女性占56.55%(2 390/4 227)。2015-2016年,社区老年人的骨密度T值下降0.03,骨质疏松占比增幅0.97%。进一步分析显示,女性老年人的骨密度T值显著降低(-2.18±1.11)vs.(-2.24±1.11)],差异有统计学意义(paired-t=6.699,P<0.001),骨质疏松分级变化显著升高39.12%vs.41.17%],差异有统计学意义(paired-Z=3.040,P=0.002);而男性老年人的骨密度T值变化差异无统计学意义(paired-t=-1.212,P=0.226),骨质疏松分级变化差异亦无统计学意义(paired-Z=-0.663,P=0.507)。6.91%(292/4 227)的社区老年人发生骨质疏松分级加重,其中女性占7.74%(185/2 390);男性则占5.82%(107/1 837)。分不同性别,采用广义估计方程对连续2年的骨质疏松检测结果进行影响因素分析可得,女性老年人的骨质疏松的危险因素包括高龄(OR=1.078,95%CI:1.063~1.094,P<0.001)和大腰围(OR=1.017,95%CI:1.003~1.031,P=0.016),其保护因素则包括戒烟(与吸烟相比)(OR=0.195,95%CI:0.043~0.880,P=0.033)、高身高(OR=0.978,95%CI:0963~0.993,P=0.005)和高体重(OR=0.971,95%CI:0.956~0.987,P<0.001);而男性老年人的骨质疏松危险因素包括高龄(OR=1.023,95%CI:1.006~1.040,P=0.006)和高腰围(OR=1.023,95%CI:1.003~1.043,P=0.026),其保护因素则包括从不吸烟(与吸烟相比)(OR=0.815,95%CI:0.668~0.993,P=0.042)和高体重(OR=0.969,95%CI:0.951~0.988,P=0.001)。结论整体上看,2015-2016年社区65岁及以上的老年人骨质疏松占比增幅不大,主要体现在女性老年人群,而值得注意的是将近8%的女性老年人发生骨质疏松分级加重。年龄、体重、腰围及吸烟均对骨质疏松的发生发展起关键影响作用。因此,在进行社区老年骨质疏松健康防治时,应特别关注女性老年群体,同时对吸烟人群、肥胖人群进行针对性健康教育,以期有效防治骨质疏松。

Follow-up of osteoporosis among the elderly in a community in Shanghai Municipality, 2015-2016

Objective To analyze the occurrence, development and variation of osteoporosis and its key influencing factors among the community elderly through following-up the monitoring Results of bone mineral density of the elderly aged 65 years and above in a community in Shanghai Municipality from 2015 to 2016, and to provide references for prevention, control and management of osteoporosis among the community elderly. Methods A questionnaire survey (including general situation and lifestyle) and bone mineral density test were conducted among 4,624 elders who participated in the community health examination on two successive years (during the years of 2015-2016) in a community in Shanghai Municipality. SPSS 23.0 software was used for statistical data analysis. Paired-samples t-test was used for analyzing the changing differences in the T value of bone mineral densityof the elderly on two successive years. Symbols Wilcoxon rank test was used for analyzing the changing differences in the grades of osteoporosis of the elderly on two successive years. Generalized estimating equation was established to analyze the effects of general situation and lifestyle on osteoporosis of the elderly. Results The effective data about 4,227 cases were collected during this study,with the effective rate being 91.41%. Among the 4,227 elders, males and females accounted for 43.46% (1,837/4,227) and 56.55% (2,390/4,227) respectively. The T-value of bone mineral density in the community elderly during 2015-2016 reduced 0.03, while the proportion of osteoporosis increased 0.97%. Further analysis showed that the T-value of bone mineral density in the female elderly was significantly declined ((-2.18±1.11) vs. (-2.24±1.11)), while the changes in the grading of osteoporosis were significantly increased (39.12% vs. 41.17%), both showing statistically signficant differences (paired-t=6.699, P<0.001; paired-Z=3.04, P=0.002). No statistically signficant differences were found in the changes in the T-value of bone mineral density (paired-t=-1.212, P=0.226) and the grading of osteoporosis (paired-Z=-0.663, P=0.507) among the male elderly. 6.91% (292/4,227) of the community elderly suffered from aggravating osteoporosis, of which the females and males accounted for 7.74% (185/2,390) and 5.82% (107/1,837) respectively. The Results of generalized estimating equation analysis based on different genders showed that the risk factors for osteoporosis in the elderly were advanced age (females: OR=1.078, 95%CI:1.063-1.094, P<0.001; males: OR=1.023, 95%CI:1.006-1.040, P=0.006) and big waist circumference (females: OR=1.017, 95%CI:1.003-1.031, P=0.016; males: OR=1.023, 95%CI:1.003-1.043, P=0.026).The protective factors for osteoporosiswere smoking cessation (compared with smoking, OR=0.195, 95%CI:0.043-0.880, P=0.033), tall height (OR=0.978, 95%CI: 0963-0.993, P=0.005) and heavy body weight (OR=0.971, 95%CI:0.956-0.987, P<0.001) in the females, andnever smoking (compared with smoking, OR=0.815, 95%CI:0.668-0.993, P=0.042) and heavy body weight (OR=0.969, 95%CI:0.951-0.988, P=0.001) in the males. Conclusions On the whole, there was a small increase in the proportion of osteoporosis among the community elderly in Shanghai Municipality from 2015 to 2016, and it mainly reflected in the female elderly. It is worth noting that nearly 8% of the female elderly suffer from aggravating osteoporosis. Age, weight, waist circumference and smoking play the important roles in the occurrence and development of osteoporosis. Therefore, special attention should be paid to the female elderly during the process of osteoporosis prevention and treatment; meanwhile, targeted health education should be conducted among smokers and obese elders so as to effectively prevent and cure osteoporosis.